Healthcare Provider Details

I. General information

NPI: 1821997644
Provider Name (Legal Business Name): ADVANTAGE MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 S 900 W STE 4
RIVERDALE UT
84405-3664
US

IV. Provider business mailing address

590 GREENWOOD DR
BRIGHAM CITY UT
84302-4736
US

V. Phone/Fax

Practice location:
  • Phone: 801-392-2463
  • Fax:
Mailing address:
  • Phone: 435-734-0488
  • Fax: 435-734-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KORY S YOUNG
Title or Position: VP
Credential:
Phone: 801-807-9395